Closer collaboration between the government and private-pay senior living operators are needed to maintain assisted living quality and affordability in the years to come.
That’s according to Gardant Management Solutions Co-president and COO Julie Simpkins, who spoke Thursday at a U.S. Senate hearing spurred by the Washington Post’s series of articles highlighting elopements and staffing issues in assisted living and memory care communities.
The hearing – the first at the federal level for assisted living in two decades – was organized by Sen. Bob Casey (D-Pa.) in his role chairing the Senate Special Committee on Aging and included questioning from leaders including Sens. Elizabeth Warren (D-Ma.), J.D. Vance (R-Ohio), John Fetterman (D-Pa.) and Mike Braun (R-Ind.).
It was meant to address what the politician has called “a set of cascading crises” related to quality and the high cost of senior living services, he said.
The Post stories detailed how 100 senior living residents died after wandering away from their assisted living and memory care communities since 2018, as well as chronic understaffing in the senior living industry.
Industry advocates have stressed that such incidents remain rare in senior living, noting that the Washington Post reporting represents just a small number of the many residents who safely live in senior living communities.
In her testimony Thursday morning, Simpkins echoed the sentiment that such cases, although tragic, are rare and not reflective of the wider industry.
“The overwhelming majority of families and residents have a life-affirming, safe experience,” she said during the hearing. “Assisted Living providers are committed to upholding our policies and procedures as well as continuing to learn all that we can about dementia dementia care to prevent these incidents.”
Gardant stands as one of the nation’s largest providers of assisted living in the nation with 80 communities as of last year. The company’s model is unique in that it relies on both a mix of private-pay senior living rates and Medicaid waivers from states that include its home state of Illinois.
Through that approach, Gardant has been able to expand its portfolio of affordable assisted living communities, all while maintaining a high occupancy and low turnover rate. But the company’s growth in that regard is limited to states with robust Medicaid waiver programs, Simpkins said.
Expanding those programs to other states and incentivizing more public-private partnerships could help other operators achieve similar results, she said.
“With a rapidly growing elderly population, we need a public and private partnership to incentivize more providers to develop these models,” Simpkins said at the Senate hearing. “From expanding more affordable long-term care options to workforce programs addressing the growing caregiver shortages, these efforts could make a real difference.”
Simpkins’ appearance at the Senate hearing was preceded by a year of growth and evolution for Gardant. She assumed her role as co-president along with Greg Echols in April, months before the company took on 22 former Pathway to Living communities in Illinois and Ohio.
‘Collaborative, comprehensive solutions’
Today, Gardant serves about 6,000 older adults through the Medicaid waiver program. But building an affordable assisted living model like Gardant’s has required “an entirely different business model altogether,” Simpkins said.
To that end, the company has over the years “had to persistently seek out HUD loans and income tax credits to stay viable,” she added. But private investors have also played a role in keeping the company afloat.
“We relied heavily on the state regulators and the resources within the state to help coach, educate and resource, everything we needed to do [during Covid],” she said. “I don’t believe that could have happened at the federal level, the amount of attention we were able to get from the state.”
Despite an increased cost of care in recent years, including workforce and insurance costs, operating margins for Gardant remain around 20% and 28%. At the same time, the company has kept its occupancy to 96% while trimming turnover for executive directors.
Simpkins noted there are sections of the country where low- and middle-income residents are well-served, but that national coverage is spotty due to a lack of programs for access to affordable housing in each state.
Government involvement would need to focus on a variety of factors, including workforce shortages and expanding funding programs to reduce the cost of assisted living for residents, she said.
The senior living industry has long been wary of accepting dollars from the government if they also come with increased oversight. And to that end, Simpkins noted she believes that “every state, every community and every resident is different,” and thus not easily governed federally.
“Efforts to standardize all assisted living communities would be both unworkable and irresponsible for resident care,” she said. “We need collaborative comprehensive solutions that ensure our ability as assisted living communities to continue doing what we do best, providing safe quality care to our residents.”
Senior living industry associations also weighed in on the need for more public-private partnerships.
Argentum noted in written testimony Thursday that it supports policies to improve access and affordability of assisted living, “such as strengthening the long-term care insurance market [and] expanding tax-advantaged savings plans already in place to make it easier to save for long-term care needs.”
The organization also sees a need to increase reimbursement rates for public programs “to allow more people to benefit from assisted living.”
But the organization also believes that such moves should be regulated on the state-level as opposed to federally.
“Assisted living communities are licensed and regulated in all 50 states. This regulatory framework encourages states to innovate and explore ways to provide cost-effective, person- centered, long-term care at a much more local level than could ever be replicated by one-size- fits-all federal regulations,” said Argentum Senior Vice President of Public Affairs Maggie Elehwany.
LeadingAge CEO Katie Smith Sloan said that older adults and their families need more help accessing assisted living and other kinds of care.
The organization offered recommendations that included establishing and funding a national resource center for assisted living staff training, including in dementia care; increasing funding through the Department of Health and Human Services’ (HHS) Administration on Community Living program; and authorizing funds to study barriers to states offering Medicaid assisted living.
“If the lack of federal government support continues, the impact will be felt by each and every one of us,” she said in a statement Thursday. “We can do better. A comprehensive and equitable long-term care financing system would make all the difference.”
Calls for more transparency, oversight
The hearing Thursday also included testimony from assisted living experts and advocates. All agreed that more must be done to maintain quality and affordability of assisted living services.
Among the witnesses at the hearing was Patty Vessenmeyer, a Pennsylvania resident whose husband had been in assisted living and required memory care services. According to Vessenmeyer, it cost around $13,000 per month, between paying for a caregiver and room fees to house him in the community.
“If he hadn’t passed away, rather quickly, by the length of time he was in there, it would have used up all of my nest egg,” Vessenmeyer said.
Dr. Jennifer Craft Morgan, who is director and professor at Georgia State University’s gerontology institute, noted how assisted living is “marketed to those who can afford it with a hospitality mindset.”
“They advertise and compete on the basis of beautiful campuses, luxury food and furnishings and concierge services,” she said. “This model encourages residents and families to think about this next step as though they’re going to a hotel or resort.”
She recommended creating standards for initial and continuing education training for direct care workers and assisted living staff, professionalizing the direct care workforce, incentivizing and rewarding good employers who deliver high quality care, increasing access to assisted living, improving care coordination resources for people living with dementia and their care partners, and support standardization of monitoring and resources to increase state-based oversight and transparency.
Over the last few decades, assisted living residents have grown frailer, public payment sources have become more common and operators have become more sophisticated. But “we as a country have failed to keep up with these trends,” said Richard Mollott, executive director of the Long Term Care Community Coalition (LTCCC), based in New York City.
“Too many residents and families are at risk for financial exploitation and even fraud, too many seniors and families get taken in by promises – quote, unquote, memory care and aging in place – when in fact these are more often marketing terms and accurate representations of specialized care,” he said.
He also noted that it’s hard for families to glean independent information on assisted living, not to mention policymakers. In the absence of such information, they often rely on senior living marketing materials and referral services like A Place For Mom.
Mollott said state websites are often “flimsy” and have very little information for consumers such as staffing, costs and quality.
Mollott added assisted living has reached around the same point in need for additional oversight that nursing homes reached in the 1980s.
“Assisted living facilities now care for people who in many ways have the same needs and vulnerabilities as nursing home residents,” he said. “From numerous GAO reports to the growing chorus of local and national news reports of neglect, disastrous “elopement” and financial shenanigans, it is clear that we have reached that point now with assisted living.”
“I think it’s time for the federal government to step in,” he said.
He proposed establishing new national standards to promote “quality, safety and integrity” in assisted living, building a national assisted living database to help the public determine costs and quality, and promoting resident and family engagement “to ensure that assisted living is truly a home- and community-based service.”